Inclusion criteria were age >18 years, single stroke of ≥3 months duration, unilateral upper limb weakness, completed
upper limb rehabilitation, and the presence of motor-evoked potentials in response to transcranial magnetic stimulation with the muscles either at rest or preactivated (to ensure potential for functional improvement14). Exclusion criteria were contraindications to transcranial magnetic stimulation (eg, epilepsy or seizures), cardiac pacemakers or metal implants in the head, severe spasticity (≥4 on the Modified Ashworth Scale [MAS]15), wheelchair-bound, or presence of dysphasia or cognitive dysfunction sufficient to limit the ability to provide click here informed consent. All participants received 12 sessions (4wk) of TST with an experienced neurophysiotherapist
(S.F.R.L.). Each 30-minute session was divided into 6 sections of 5 minutes: stretching and warm-up, http://www.selleckchem.com/products/BKM-120.html grasp, grip, pinch, gross movements, and patient choice. The tasks were based around those required for the Action Research Arm Test (ARAT)16 and were practiced in a pseudo-randomized order in each session.10 Demographic and clinical variables were chosen that are commonly assessed in survivors of stroke in clinical and/or research settings and could be logically thought to have a potential influence on the amount of paretic arm use. Data were obtained from the assessments of the RCT. These variables included age, time since stroke (chronicity), Barthel Index,17 MAS,15 baseline ARAT,18 baseline upper RVX-208 limb Fugl-Meyer Assessment (FMA),19 and change in ARAT and FMA 3 months after TST. The ARAT and FMA are standardized measures of upper limb function.16, 18 and 19 The ARAT is formed of 4 subsections: grasp, grip, pinch, and gross. Each task is scored out of 3 (high score means good function, maximum of 57). The FMA is formed of 4 subsections: shoulder, wrist, hand, and coordination. Each task is scored out of 2
(high score means good function, maximum of 66). The subsection scores were also included as potential predictors. The dependent variables were the average baseline MAL amount of use and the change 3 months after TST. The MAL requires participants to report how much (amount of use) they use their affected arm for a selection of daily activities. Ratings are from 0 (arm not used at all) to 5 (used as much as before the stroke). After confirmation that the 2 baseline assessments were not statistically different (paired t tests), mean values were used for the ARAT, FMA, and MAL. Spearman correlations were performed to determine whether clinical and demographic factors ( table 1) correlated with baseline MAL amount of use rating. Forward stepwise multiple linear regression analysesa were conducted to explore the variables that predicted baseline MAL amount of use and change in the amount of use 3 months after TST.